HomeMy WebLinkAboutREV22-0960 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application
Comm'I r Residential � City of Newport Beach - Building Division
W TE: PLAN CHECK FEES DUF AT TIME nF ci iRNniTrni
jouilding F_ Grading rainage _ Elec F_Mech F'-Plum CuYdCut l CuYdFill
Project Address (N ' mg address) [ Flood Fire F_ Liq F- Landslide F_N/A Floor Suite No
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Description of Work
Use. Const Type I �`
# Stories # Units (if Res)r
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Valuation $ e-.
Material/Labor /Qdo
New/Add SF �i�_ Remodel SF 3j07 Garage/New/Add—
OWNER'S NAME Last / First �Ffi/i✓
Owners Address Owner's E-mail Address
2 575_
�,ay ,nc/%�-19�72�-+a�t%G , comer
City State ��gg��
---�"R-- Zip `�GYIZg— Telephone—
APPLICANT'SNAME Last �y�?'LZ First
Applicant's Address Applicant's E-mail Address
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City State Zip Z�7�c Telephone ��(^ 7 Z�23
ARCHITECT/DESIGNER'S NAME li& r
Last ry cC y^� First S�?Fi�/ Lic. No. L' P z
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ArchitectMesigner's Address Architect/Designers E-mail Address
223a �.erles�otsJ3�- �'.2aZ
City L —- -_- State Zip 7prr3/ Telephone y[��5._ZUJU
ENGINEER'S NAME Last First Lic. No.F_
Engineers Address Engineer's E-mail Address
City State F® Zip F TelephoneF_
CONTRACTOR'S NAME/COMPANY Lic. No. Class
Contractors Address Contractor's E-mail Address
City (i ir/d State I " Zip Telephone y,4q ZW-,___19z_�
SETBACKS REAR SETBACKS FRONT PERMIT NO. w2L O9�
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. 0 mil 7aZZ
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $